• Senior Chair Workout Health Questionnaire PARQ

    For participants aged 60+

  • 1. Participants Details

  • Date of Birth*
     - -
  • Country of Residence

  • 2. Health Screening Questions

    Please tick YES or NO
  • Has your doctor ever told you that you have a heart condition or should only do physical activity recommended by a doctor?*
  • Do you ever feel pain, pressure, or tightness in your chest during activity?*
  • Do you often feel dizzy, lightheaded, or lose your balance?*
  • Do you have joint, bone, or back problems that could worsen with exercise?*
  • Are you currently taking medication for blood pressure or heart conditions?*
  • Have you had recent surgery, injury, or medical treatment that may affect exercise?*
  • Has a doctor ever advised you to avoid certain types of exercise?*
  • Do you have any other health condition we should know about?*

  • 3. Mobility and Movement Ability

  • 1) Can you stand up from a chair without assistance?*
  • 2) Are you comfortable doing gentle standing exercises?*
  • 3) Are you able to maintain balance while standing (holding a chair if needed)?*
  • 4) Are you comfortable getting down to the floor and back up again?*
  • 5) Are you able to perform light floor exercises such as glute bridges?*

  • 4. Health Notes

  • 5. Exercise Participation Statement

  • I understand that participation in exercise involves physical movement and may carry a small risk of injury.

    I will exercise at my own pace and stop if I feel pain, dizziness, or discomfort.
    If I have any concerns about my health, I will consult my doctor before participating.

  • 6. Online Class Safety

  • These classes are delivered online via Zoom.
    Participants are responsible for ensuring they have a safe space to exercise, including:
    • A stable chair
    • Enough room to move safely
    • Supportive footwear or non-slip flooring

  • 7. PARTICIPANT DECLARATION

  • I, the undersigned, have read and understood this questionnaire and completed it to the best of my knowledge.

    I understand this form is valid for 12 months from the date completed and must be updated if my health changes.
    I acknowledge that the instructor will retain this form confidentially in accordance with applicable data protection laws.
    I confirm that the information provided is accurate and that I participate voluntarily.

     

  • Date*
     - -

  • If you answered YES to any of the questions above, we may contact you for more information before you start. In some cases, you may be advised to consult your GP before participating.

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